Alternatives to blood transfusion
|Wiliam Harvey demonstrating the circulation of the blood. iStock.|
In 1616 William Harvey first discovered how blood circulates around the body. This discovery stimulated research into transfusing blood from one person to another. Early attempts to replace blood began with liquids such as milk, both animal and human, urine, and beer. Sir Christopher Wren in the seventeenth century even suggested opium or wine as blood substitutes. The first blood transfusion was carried out between two dogs by Jean-Baptiste Denis in 1667. The blood vessels were cut and blood transferred directly by quills from one dog to the other. Denis later transfused sheep’s blood to a fifteen-year-old adolescent and also to a laborer, both of whom survived (Mandal, A 2019).
Each year about 2.5 million units of blood are given in transfusions in the United Kingdom, and there are not enough people volunteering as blood donors to cope with the demand. Only 4% of the population eligible to donate do so on a regular basis. The National Health Service requires over 130,000 new donors each year to ensure that enough blood from all blood groups is available when required.
The discovery in 1901 of the different types of blood groups by Karl Landsteiner was fundamental in the development of safe blood transfusions. Landsteiner identified three of the four blood groups, namely A, B, and O. Two years later one of his colleagues discovered the fourth blood group, AB. As research continued into an alternative to blood that could be used for transfusions, the development of Hartman’s solution or Ringers Lactate in 1883 was a positive step forward. It could be used to replace fluids and electrolytes and increase fluid volume in the body, but did not replace the function of the red blood cells in transporting oxygen.
Events in the twentieth century accelerated research into alternatives to blood transfusion. The two World Wars, terrorism, and an increase in the treatment of diseases and trauma all increased the demand for blood, leading to more research being conducted. In 1936 Bernard Fantus opened the first blood bank in Chicago, and the following year the first blood bank in England opened in Ipswich.
As World War II greatly increased the need for blood, thousands of people began donating their blood; blood banks opened in Britain, America, and then in most developed countries. But the ability to store blood led to the reduction of research into blood alternatives, as it was felt that blood alternatives were not necessary (History Of Blood 2019).
In the 1970s and 1980s patients suffering from hemophilia were found to have become infected with hepatitis or Human Immunodeficiency Virus in the course of receiving clotting factors to prevent bleeding. There were also cases of patients dying from Creutzfeldt-Jakob disease after being transfused with contaminated blood. This once again stimulated research into blood substitutes.
The first to be approved in the United States in 1989 was a perflurorocarbon-based product called Fluosol-DA-20. Manufactured in Japan by Green Cross, it had limited success and caused side effects, and its approval was rescinded in 1994. The other main type of blood substitute is the hemoglobin-based oxygen carrier called Hemopure, which is bovine in origin. It is manufactured by the Biopure corporation and is a highly purified oxygen-carrying hemoglobin solution (Pacific heart, Lung and Blood Institute).
There are many advantages to using a blood substitute such as Hemopure. It does not have to be typed to match the blood type of the patient and can be given immediately in emergencies. It also does not have to be kept refrigerated and has a long lifespan of about three years as opposed to about forty days for donated blood (Barbat, A. 2018). Furthermore, it can be given to people who cannot accept blood transfusion because of their religious beliefs, such as Jehovah’s Witnesses (Watchtower 2013).
There are, however, risks involved in using blood substitutes, namely volume overload and an increased risk of blood clotting, which may cause a stroke or myocardial infarction. As the effects of these products do not last long, they are only a short term replacement for donated blood, lasting in the body for about thirty hours, whereas donated blood lasts in the body for about thirty-four days. They should therefore be considered only a bridge to provide the body time to generate more red blood cells (Barbat, A. 2018).
It is therefore more appropriate to call these products oxygen carriers rather than blood substitutes, because unlike blood they do not contain any coagulation factors, antibodies, or cells; their only function being to temporarily replace red blood cells and increase blood volume. They may also be useful in emergencies in some less developed countries where hepatitis or HIV is more likely to be transmitted by blood transfusion. With further research, new products could be developed to perform all the functions of blood but without the problems associated with blood transfusions (Kramer, G, et al 2009).
- Artificial Blood Substitutes. Pacific Heart, Lung and Blood Institute. Artificial Blood https;//www.ph/bi-org/division/blood-disorders/artificial-blood.
- Barbat, A (2018). Hemopure; An Alternative To Blood Transfusion. Department of Anaesthesiology, College of Medicine. Https://anest.ufl.edu/…/os/hemopure-an-alternative-to-blood transfusion.
- Blood Substitute. Wikipedia. Https://en.wikipedia.org/wiki/fluosol.
- History of Blood (2019). health.gov.mt https;//deputyprimeminister.gov.mt/en/nbts/Pages/About-Blood/History.
- Mandal, A. (2019). History of Blood transfusion. News Medical Life Sciences. News-medical.net
- Mikami, H. (2019). Artificial blood developed for patients of any blood type. The Asahi Shimbun. www.asahi.com/com/ajw/articles/AJ20190929oo1.html
- Renault, M. (2019). Searching In Vein: A history of artificial blood. Popular Science. Https://www.popsci.com’artificial-blood-history-science
- Scott, M.G. ET AL (1997) Blood Substitutes; evolution and future applications. Clinical Chemistry. Clinchem.aaccin/s.org/content/43/9/1724
- Suman, S. (2008). Indian Joiurnal of Critical Care Medicine: Peer Review. Indian Society of Critical Care Medicine. July-September 12(3): pp140-144. Europepmc.org7abstract7med
- Yuchen, J. Scerbo, M. Kramer, G. (2009). Examining The History of haemoglobin-Based Oxygen Carriers. Https;//www.ncbi.nlm/nih.gov/pmc/articles/pmc2729196
- Watchtower-blood.org/basics/ ajwrb.org/wtower-approves-hemopure 4/5/13
GERALDINE MILLER worked as a staff nurse in the cardio-thoracic department, on a male surgical ward specializing in cardiac pulmonary surgery. It was both a pre-operative and post operative ward caring for patients after cardio-pulmonary bypass grafts or pneumonectomy and lobectomy surgical procedures.
Submitted for the 2019–2020 Blood Writing Contest